clinical

Question 1

4 D’s of diagnosis

Answer 1

Deviance, distress, dysfunction and danger. Psychologists look at these when diagnosing patients.

Davis (2009) believes that a 5th D needs to be added- duration -which increases validity

Question 2

evidence for unreliability in diagnosis

Answer 2

Spitzer and Williams 1985 reviewed the process of diagnosis and suggested that experienced psychiatrists only agree on diagnosis about 50% of the time

Ward (1962) studied 2 psychiatrists diagnosing the same patients and found that unreliability occurred because of the inconsistency of psychiatrists interpretations of symptoms (32.5%) and inadequacy of the diagnosis system (62.5%)

Question 3

Evidence for reliability of diagnosis

Answer 3

Brown (2002) tested the reliability and validity of DSM5 diagnosis for anxiety and mood disorders and found them to be good to excellent.

Question 4

owen 1978

Answer 4

found that from post mortem examinations of people with schizophrenia, they found that they had a higher density of dopamine receptors in the cerebral cortex than who had not suffered from schizophrenia. Gives evidence for more dopamine receptors in the mesolimbic system.

Question 5

Brown and Birley 1968-social conditions and schizophrenia

Answer 5

Found that 50% of schizophrenic patients reported a major life event in the 3 weeks prior to relapse suggesting that social conditions may trigger a relapse.

Question 6

Lurrhman

Answer 6

found that auditory hallucinations vary cross culturally.

Question 7

Hilker et al- heridability for schizophrenia

Answer 7

suggests that there is a 79% heritability rate for schizophrenia.

Question 8

Wright (2014)-genes and schizophrenia

Answer 8

suggests that as many as 700 genes had been linked to schizophrenia such as the COMT gene (causes DiGeorge syndrome which causes 25% of people with this syndrome to develop schizophrenia) and the DISC1 gene (people with this gene are 1.4x more likely to develop schizophrenia)

Question 9

Gottesman and Shields- schizophrenia

Answer 9

Found that the concordance rate (their twin study) for severe schizophrenia was much higher in monozygotic twins 75% compared to dizygotic twins 22%. Provides evidence that genes do have a basis for the development of schizophrenia.`

Question 10

Eaton- urbanicity and schizophrenia

Answer 10

Suggests that city life is more stressful than rural life and long term exposure to stressors can trigger an episode of schizophrenia.

Question 11

Vassos et al- urbanicity and schizophrenia

Answer 11

who found by analysing 4 studies in Sweden, the Netherlands and Denmark including 24,000 cases of schizophrenia found that the risk of schizophrenia was 2.37x higher in the most urban environments compared to rural environments.
However, this is a correlation so not all extraneous variables have been controlled for so the study cannot prove that urbanicity causes schizophrenia. Social drift hypothesis may be a better explanation.

Question 12

Faris- social isolation

Answer 12

suggested that social isolation where people are cut off from family and friends may lead to the symptoms of schizophrenia- as they do not get any feedback from others on behaviour which is inappropriate. Faris suggested that his theory was supported by people in solitary confinement that go on to develop schizophrenia.

Question 13

Veling- schizophrenia and minority status and immigration

Answer 13

gathered data through self report questionnaire data to suggest that schizophrenia may be a reaction to long term prejudice and discrimination of an outgroup.

Question 14

Popovich- family dysfunction, childhood trauma and schizophrenia.

Answer 14

suggests that childhood trauma makes individuals more likely to develop schizophrenia.

Question 15

Menzies-OCD

Answer 15

Found people suffering from OCD had different amounts of grey matter in the orbitofrontal cortex

Question 16

Whiteside et al-brain functioning and ocd

Answer 16

In patients with OCD, the cingulate gyrus, basal ganglia and orbitofrontal are active when compared to controls. Shows a difference in brain functioning.

Question 17

Genetic explanation for OCD- Carey and Gottesman

Answer 17

Found an 87% of MZ twins concordance rate for obsessive symptoms compared to a 47% rate for DZ twins

Question 18

Franklin et al

Answer 18

Created the idea of habituation training.
Franklin et al found that between 55%-75% of clients doing ERPT showed improvement and the improvement lasted between 5-6 years.

Question 19

Soomro- effectiveness of drugs and OCD

Answer 19

Found that anti-depressants were more effective than placebo in reducing symptoms of OCD. Gives scientific credibility.

Question 20

POTS- drug treatment effectiveness and CBT

Answer 20

Drug treatment can be combined with CBT and has been shown to raise the effectiveness of CBT.

Question 21

Koran- antidepressant medication and relapse- OCD

Answer 21

Found that anti-depressant medication did have a long term effect compared to a placebo and was effective at preventing relapse over an 80 week trial.

Question 22

Ravizza- individual differences and SSRIs being not effective

Answer 22

Found that SSRIs were not effective for 40% of people.

Question 23

Brody et al- individual differences and metabolism

Answer 23

Found that differences in the metabolism in the right compared to the left orbitofrontal cortex predicts whether a person will respond better to drugs or CBT

Question 24

Franklin- what is habituation training

Answer 24

The client is repeatedly asked to think about their obsessive thoughts. The idea is that by deliberately thinking about their obsessions they will become less anxiety causing compulsive behaviour to not be required.

Question 25

Overbeek- ERPT with comorbid OCD and depression

Answer 25

Found that a third of participants with OCD also had clinical symptoms of depression. This group showed less improvement when treated with ERP and drug treatment combination compared with a group of participants with only OCD symptoms.

Question 26

Masellis et al-cbt obsessions

Answer 26

Found that a substantial proportion of clients (up to 44%) only suffer from obsessions. They found that obsessions are more associated with distress than are compulsions, however current treatment often focuses on treating the compulsions which may not alleviate the distress. This study indicates the need for therapy to refocus on obsessions and alleviating symptoms of depression to get a better outcome for sufferers.

Question 27

List the 4 steps commonly used in ERPT

Answer 27

1- Informing the client about what ERPT is about and what it will involve
2- Creating and using an exposure hierarchy- mildly anxiety inducing situations to high anxiety inducing situations.
3- Repeated exposure to situations that cause high anxiety until the level reduces
4- Getting the client to resist and refrain from performing compulsive behaviour

Question 28

what is one common cognitive distortion that CBT tries to address?

Answer 28

Catastrophising which is when a person predicts that a negative outcome will occur and jumps to the conclusion that if it occurs it will be a catastrophe.

Question 29

What is meant by relapse rate (OCD) ?

Answer 29

Relapse rate is the rate at which people return to their obsessive and compulsive behaviour.

Question 30

What is the diathesis stress model?

Answer 30

A model which suggests that stressors in the environment interact with biological features in the individual. This could explain why not everyone with genetic predisposition for schizophrenia goes on to develop it.

Question 31

Meltzer et al- schizophrenia and drug treatment

Answer 31

Found that haloperidol gave significant improvements in all areas of functioning compared to a placebo. Gives evidence for drug treatment being effective at reducing symptoms of schizophrenia.

Question 32

Sensky et al- compared CBT with non specific befriending techniques for schizophrenia

Answer 32

Compared CBT with non-specific “befriending interventions” for patients for schizophrenia and found that CBT was more effective in reducing both positive and negative symptoms.

Question 33

NICE 2014- CBT and schizophrenia

Answer 33

Did a meta-analysis of RCTs of CBT . The analysis showed that CBT was effective in reducing hospitalisation rates for up to 18 months, reduced time spent in a hospital by on average 8.26 days and CBT also reduced symptom severity and aided psychosocial functioning at the end of the treatment and 12 months later.

Question 34

McKenna and Kingdon- evidence against CBT for schizophrenia

Answer 34

Compared CBT with routine treatment or a control non-biological treatment and found that CBT was only superior in 2 out of 9 studies.

Question 35

Kireev- functions of the brain and OCD

Answer 35

suggests that the functions usually performed by the cingulate gyrus can be taken over by other areas of the brain.

Question 36

what percentage of psychiatrists ignored pseudopatients when approached to ask “when they would be eligible for ground privileges?”

Answer 36

71

Question 37

What are the 3 steps in CBT for schizophrenia?

Answer 37

1- Belief modification- delusional thinking is challenged directly
2- Focusing and reattribution- this is used to help people with auditory hallucinations. Therapist aims to show patient that the voices are self generated.
3- Normalising the experience of the person with schizophrenia- faulty thinking is challenged and patients are taught to look at their experiences rationally

Question 38

Sher et al- memory problems in OCD

Answer 38

Found that people with OCD had poor memories for their actions. This may then cause the checking behaviours and compulsive behaviours found in those with OCD.

Question 39

Williams et al 1997- hypervigilance in OCD explanation

Answer 39

Hypervigilance means that people have an attentional bias which means that they are oversensitive to threat. This is seen where they may use rapid eye movements to scan the environment, and they may attend selectively to threat related stimuli rather than neutral stimuli. The threats that are perceived therefore become the basis of their obssessions and compulsive behaviour is designed to reduce their anxiety.

Question 40

Bradshaw and Rosenborough (2004)- metaanalysis of CBT in schizophrenia

Answer 40

Undertook a meta-analysis of 22 patients and suggests that 86% improved their psychosocial functioning and 82% had reduced severity of symptoms. All 22 clients achieved more than was expected with regard to the goals of the treatment. Findings support the claim that CBT is effective in regard with regard to schizophrenia.

Question 41

Cheon et al- stigma and mental health (key question)

Answer 41

Cheon et al suggests that Asians and Asian Americans typically have more negative attitudes towards mental health rather than white Europeans and Caucasian Americans.

Question 42

Twesigye et al- stigma and mental health key question

Answer 42

Twesigye et al who found that patients suffering from Bipolar in Uganda were deterred from seeking help for mental illnesses due to the high levels of stigma associated with psychiatric disorder.

Question 43

McCabe- causes of mental disorder key question

Answer 43

McCabe who found that White British people were more likely to believe in biological causes of mental illness in comparison to African people favouring social explanations.

Question 44

Stefanovics- beliefs abt causes of mental health key question

Answer 44

Stefanovics et al research that found that people from Ghana and Nigeria had the highest level of belief in supernatural causes

Question 45

IPSS (2016)- symptoms vary cross culturally key question

Answer 45

found that in developing countries people were likely to have one episode of schizophrenia compared with developed countries where continuous schizophrenia is more likely

Question 46

WHO 2001- stigma mental health key question

Answer 46

argues that stigma regarding mental health can cause a mark of shame, disgrace or disapproval which could cause people to be rejected from society.

Question 47

Vallentine- interviews in clinical psych APRC

Answer 47

Aim: to study the effectiveness of psychoeducation within group work for offender patients in a high security forensic hospital setting (Broadmoor).
Participants: There were 42 males who were detained in Broadmoor High security hospital most of whom had received a diagnosis of schizophrenia or similar. They were part of a programme helping them cope with their illness.
Method: The participants were interviewed using the semi-structured interview technique. The aim of the interviews being to understand their experience better, but also to get information on how they can improve better. The group ran for 20 sessions and over a 3 year period. The psycho-education programme considered symptoms, treatment options and ways of coping with illness. Following the interviews, a content analysis was conducted on the data gathered to pick out key themes in the responses.
Results: Four key themes were identified.
1-what participants valued and why
2-what was helpful about the group
3-clinical implications
4-what was difficult and unhelpful about the group.
Some of the key findings were that patients valued knowing and understanding their illness, and the group sessions allowed them to not only understand their own symptoms but also how other peoples experiences were similar. Many also reported increased confidence in dealing with illness, which made them more positive about the future. The participants stated that they did value the group.
Conclusions: the results showed that both positive and negative in the various measures taking after the psycho-education group took place. The semi-structured interviews gave qualitative data that showed how participants valued knowledge about their illness and how this knowledge gave them power. This shows that semi-structured interviews are useful in gathering detailed rich data which could be used to inform future practices.

Question 48

Validity of diagnosis- Mason and Colleagues

Answer 48

Have shown that the diagnosis of schizophrenia has good predictive validity.

Question 49

Validity of diagnosis- Cochrane et al

Answer 49

blames the classification systems used in Britain as states that they take a “Eurocentric bias” as they cannot take into account symptoms of other cultures due to being based on European ideas.

Question 50

developmental psychology in schizophrenia

Answer 50

Thomas 2010- suggest that schizophrenia stems from abnormalities in early brain development.

Question 51

Joseph 2004- genetic explanation criticism of methodology

Answer 51

Argued that MZ twins may be raised more similarly than DZ twins

Question 52

What percentage of patients in the CBT alone and drugs alone condition entered remission?

Answer 52

CBT alone= 39.3%
Drugs alone= 21.4%

Question 53

Rosenhan A01

Answer 53

-8 pseudopatients
-12 hospitals in 5 states
-All diagnosed with schizophrenia except for one who was diagnosed with manic depression with psychosis.
-Average stay in hospital was 19 days but ranged from 7 to 52
-71% of times patients were ignored when asking for ground privileges and only 2% of cases they were given a verbal response
-41 patients were rated by one staff member as a pseudo patient and 19 were rated by two staff members
-Average amount of attention given was 6.8 minutes

Spitzer claims that Rosenhan’s research is damaging and sensationalist.